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Objective: The ability to assess a patient’s risk of harm to self or others is a core competency for mental health clinicians which can have significant patient outcomes. With the growth of simulation in medical education, there is an opportunity to enhance education outcomes for psychiatric risk assessment. The purpose of this study was to determine how simulation is used to build competency in risk assessment and map its educational outcomes. Methods: The authors conducted a systematic scoping review using the Arksey and O’Malley framework. Electronic database searches were conducted by an academic librarian. Studies published before August 2022 which described simulation activities aimed at training clinicians in suicide, self-harm, and/or violence risk assessment were screened for eligibility. Results: Of the 21,814 articles identified, 58 studies were selected for inclusion. The majority described simulations teaching suicide risk assessment, and there was a notable gap for building competency in violence risk assessment. Simulation utility was demonstrated across emergency, inpatient, and outpatient settings involving adult and pediatric care. The most common simulation modality was patient actors. A smaller subset implemented technological approaches, such as automated virtual patient avatars. Outcomes included high learner satisfaction, and increases in psychiatric risk assessment knowledge, competency, and performance. Conclusion: Simulation as an adjuvant to existing medical curricula can be used to teach risk assessment in mental health. Based on the results of our review, the authors provide recommendations for medical educators looking to design and implement simulation in mental health education.

Objective: Virtual reality (VR) simulation is changing the landscape of simulation-based medical education. Immersive VR allows users to interact with a computer-generated environment and digital avatars using a VR headset and controllers. However, current literature regarding the use of immersive VR simulation in psychiatric medical education is sparse. This study describes its use and considerations regarding tolerability. Methods: At a mental health hospital in Canada, two immersive VR suicide risk assessment (SRA) case simulations were developed. These simulations have participants interview VR patients to characterize their suicide risk, offering a novel and safe way to engage healthcare providers in SRA training. Regarding user tolerability of these VR simulations, the Simulator Sickness Questionnaire (SSQ) was administered to participants after the simulation to characterize any motion sickness symptoms experienced. Results: Of the 22 participants in this study, the overall SSQ scores demonstrated good tolerability of the VR SRA, with the majority of participants reporting no or minimal simulator sickness symptoms. Moreover, the majority of participants reported being satisfied with this training and that the VR SRA simulation enhanced their learning experience. Conclusion: These study findings are novel, given the current dearth of data regarding the use of immersive VR in simulation-based psychiatric medical education. Further studies exploring the educational effectiveness of VR SRA in simulation-based psychiatric medical education are indicated.

To examine how project Extension for Community Healthcare Outcomes–Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients.

We present the case of a 42-year-old female with major depressive disorder who received a Roux-en-Y gastric bypass and subsequently decompensated in her depression symptoms and began newly engaging in problematic alcohol use. Top experts in the consultation-liaison field, specifically bariatric surgery psychiatry, provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the presurgical psychosocial assessment, pertinent perioperative psychopharmacology, and problematic alcohol use after bariatric surgery.

Objectives Our objective was to assess the effects of mental health interventions for children, adolescents, and adults not quarantined or undergoing treatment due to COVID-19 infection.Methods We searched 9 databases (2 Chinese-language) from December 31, 2019, to March 22, 2021. We included randomised controlled trials of interventions to address COVID-19 mental health challenges among people not hospitalised or quarantined due to COVID-19 infection. We synthesized results descriptively due to substantial heterogeneity of populations and interventions and risk of bias concerns.Results We identified 9 eligible trials, including 3 well-conducted, well-reported trials that tested interventions designed specifically for COVID-19 mental health challenges, plus 6 other trials with high risk of bias and reporting concerns, all of which tested standard interventions (e.g., individual or group therapy, expressive writing, mindfulness recordings) minimally adapted or not specifically adapted for COVID-19. Among the 3 well-conducted and reported trials, 1 (N=  670) found that a self-guided, internet-based cognitive-behavioural intervention targeting dysfunctional COVID-19 worry significantly reduced COVID-19 anxiety (standardized mean difference [SMD] 0.74, 95% confidence interval [CI], 0.58 to 0.90) and depression symptoms (SMD 0.38, 95% CI, 0.22 to 0.55) in Swedish general population participants. A lay-delivered telephone intervention for homebound older adults in the United States (N=  240) and a peer-moderated education and support intervention for people with a rare autoimmune condition from 12 countries (N=  172) significantly improved anxiety (SMD 0.35, 95% CI, 0.09 to 0.60; SMD 0.31, 95% CI, 0.03 to 0.58) and depressive symptoms (SMD 0.31, 95% CI, 0.05 to 0.56; SMD 0.31, 95% CI, 0.07 to 0.55) 6-week post-intervention, but these were not significant immediately post-intervention. No trials in children or adolescents were identified.Conclusions Interventions that adapt evidence-based strategies for feasible delivery may be effective to address mental health in COVID-19. More well-conducted trials, including for children and adolescents, are needed.

Objective: The use of virtual learning in psychiatric education has been required to address COVID-19-related challenges. Research regarding the implementation of virtual teaching environments and standardized patients for simulation remains limited. Here, educators’ outcomes were evaluated following a transition from in-person teaching with “real” patients, to a standardized patient-based simulation in pre-clerkship psychiatric clinical skills teaching for medical students. Methods: The Integrated Clinical Experiences course at the University of Toronto is a pre-clerkship clinical skills curriculum for second-year medical students. Four psychiatric clinical skills sessions were transitioned from in-person teaching to virtual teaching environments with standardized patient-based simulation. Educators (tutors) were assigned to teach groups of four to seven medical students, with a total of 45 groups. Tutors were then asked to complete an online questionnaire, and data was analyzed by quantitative and qualitative means. Results: Of 30 tutors, 21 (75.0%) had previously taught the course for an average of 6.52 ± 6.85 years. Twenty-four of 30 (80%) tutors described their ease of virtual teaching as “extremely easy” or “moderately easy”. Twenty-three of 30 (76.6%) were “extremely satisfied” or “moderately satisfied” with standardized patient-based simulation. Various advantages and disadvantages of the virtual teaching environment with standardized patient-based simulation were identified. Conclusions: The transition to a virtual teaching environment utilizing standardized patients in a pre-clerkship simulation-based curriculum did not result in significant challenges that would limit educators’ use of these teaching tools. Implementation of virtual teaching environments with standardized patients may thus serve to address challenges related to COVID-19 and resource limitations.

Objective: Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID. Methods: Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model. Results: Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher. Conclusions: There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.

The rapid rise of cases of coronavirus disease 2019 (COVID-19) has led to the implementation of public health measures on an unprecedented scale. These measures have significantly affected the training environment and the mental health of health care providers and learners. Design thinking offers creative and innovative solutions to emergent complex problems, including those related to training and patient care that have arisen as a result of the COVID-19 pandemic. Design thinking can accelerate the development and implementation of solution prototypes through a process of inspiration, ideation, and implementation. Digital technology can be leveraged as part of this process to provide care and education in new or enhanced ways. Online knowledge hubs, videoconference-based interactive sessions, virtual simulations, and technology-enhanced coaching for health care providers are potential solutions to address identified issues. Limitations of this model include inherent bias toward utilitarian instead of egalitarian principles and the subsequent threat to diversity, equity, and inclusion in solutions. Although medical educators have embraced digital transformation during the COVID-19 pandemic, there is a need to ensure that these changes are sustained.

Bariatric surgery is an effective treatment for severe obesity; however, high rates of psychiatric comorbidity complicate bariatric surgery care. As a result, importance has been placed on the need for ongoing psychiatric support in patients undergoing bariatric surgery. Given the lack of conclusive presurgery psychosocial predictors of postoperative mental health outcomes, studies have now shifted their focus to understand the long-term psychosocial sequalae that arise after surgery. Increasing evidence has demonstrated the potential for psychiatric care to stabilize psychiatric symptoms and minimize patient distress.

Objective: The study explored knowledge, attitude, and practices of Canadian Medical Education Directions for Specialists (CanMEDS) “‘Leader” role in faculty psychiatrists in a university setting. Methods: This is a qualitative study using a thematic analysis approach. Participants were identified by purposive, convenience, and snowball sampling. Telephone interviews were conducted to explore participants’ perceptions of leadership. Qualitative analysis was carried out using a constant comparative analysis approach to identify themes across the interview data. Data was transcribed and coded into themes and categories to form an analysis of physicians’ knowledge, attitude, and practices of the CanMEDS “Leader” role. Results: Twenty-eight faculty psychiatrists participated in the study. The following themes and subthemes emerged from analysis: (a) characteristics of leadership and lack of clarity regarding CanMEDS “Leader” role (subthemes: differences between manager and leader, lack of specificity and practicality, relevance to practice) and (b) the meaning of leadership (subthemes: “positional leadership” and “everyday leadership,” physician as team leader, developing leadership skills, getting beyond “occupational adolescence”). Conclusion: Participants perceived CanMEDS “Leader” role description as a high-level vision, which needs practice-oriented guidance. Participants conceptualized the dual nature of physician leadership at an individual level and at an organizational level. Leadership training is important both in residency as well as lifelong learning.

Bariatric surgery is an empirically supported treatment for severe obesity; however, it does not directly target underlying behavioural and psychological factors that potentially contribute to obesity. Mounting evidence supports the efficacy of cognitive behavioural therapy (CBT) for improving eating psychopathology and psychological distress among bariatric patients, and telephone-based CBT (Tele-CBT) is a novel delivery method that increases treatment accessibility.

ABSTRACTIntroduction: Clozapine remains the most effective antipsychotic for treatment-refractory schizophrenia. However, ~40% of the patients respond insufficiently to clozapine. Clozapine’s effects, both beneficial and adverse, have been proposed to be partially attributable to its main metabolite, N-desmethylclozapine (NDMC). However, the relation of the clozapine to norclozapine ratio (CLZ:NDMC; optimally defined as ~2) to clinical response and metabolic outcomes is not clear.Areas covered: This narrative review comprehensively examines the clinical utility of the CLZ:NDMC ratio to reduce metabolic risk and increase treatment efficacy. The association of the CLZ:NDMC ratio with changes in psychopathology, cognitive functioning, and cardiometabolic burden will be explored, as well as adjunctive treatments and their effects.Expert opinion: The literature suggests a positive association between the CLZ:NDMC ratio and better cardiometabolic outcomes. Conversely, the CLZ:NDMC ratio appears inversely associated with better cognitive functioning but less consistently with other psychiatric domains. The CLZ:NDMC ratio may be useful for predicting and monitoring cardiometabolic adverse effects and optimizing potential cognitive benefits of clozapine. Future studies are required to replicate these findings, which if substantiated, would encourage examination of adjunctive treatments aiming to alter the CLZ:NDMC ratio to best meet the needs of the individual patient, thereby broadening clozapine’s clinical utility.

Given the high rates of psychiatric comorbidity in bariatric surgery patients, pharmacotherapy is common and could potentially influence weight loss outcomes.

We aimed to describe the rates of psychiatric medication use in bariatric surgery candidates and factors associated with psychiatric medication use.

Supplemental Digital Content is available in the text.

Objectives: Gender inequity in academic medicine persists despite increases in the number of women physicians. We sought to explore gender differences in research productivity for academic psychiatrists in Canada.Methods: In a cross-sectional study of the 3379 psychiatrists in all 17 university departments of psychiatry in Canada, research productivity, as measured by the h-index and number of publications, was compared between women and men using a negative log binomial regression model to generate relative rates (RRs), adjusted for career duration (aRR). Findings were stratified by academic rank, institution region, and institution size. A subanalysis of those with 10 or more publications was conducted as a proxy for identifying physicians on a research track.Results: Women (43% of the sample) had a lower mean (standard deviation) h-index than men (2.87 [6.49] vs. 5.31 [11.1]; aRR, 0.62; 95% confidence interval [CI], 0.54 to 0.72). Differences were significant only for junior faculty and not for associate and full professors. Comparison by number of publications followed a similar pattern (aRR, 0.46; 95% CI, 0.39 to 0.55). Among those with 10 or more publications (n= 721), differences between men and women were smaller than in the overall cohort for both the h-index (aRR, 0.77; 95% CI, 0.68 to 0.87) and number of publications (aRR, 0.62; 95% CI, 0.53 to 0.72).Conclusions: Gender differences in research productivity at the national level in academic psychiatry in Canada support a call to adopt a more systematic approach to promoting equitable opportunities for women in research, especially in early career, to improve diversity and enhance future psychiatric research and discovery.

Obesity affects individuals worldwide and is currently the 5thleading cause of death according to the WHO. Bariatric surgery is an effective strategy that produces durable long-term weight loss. There is a bidirectional interplay between mental health and obesity; with higher depression and anxiety in the obese population as well as significant effects on weight loss for people with mental health disorders.

Bariatric surgery is recognized as a durable treatment for severe obesity; however, high rates of nonattendance and patient engagement during the postoperative period remain challenges. This pre/post study evaluates a quality-improvement initiative to improve attendance at bariatric surgery program appointments and to heighten program efficiency, as measured by appointment attendance, cancellations and new assessments.

Obesity is a prevalent chronic disease in Canada. Individuals living with obesity frequently interact with medical professionals who must be prepared to provide evidence-based and person-centred care options. The purpose of this scoping review was to summarize existing educational interventions on obesity in Canada for current and prospective medical professionals and to identify key future directions for practice and research.

With ongoing gaps in obesity education delivery for health professions in Canada and around the world, a transformative shift is needed to address and mitigate weight bias and stigma, and foster evidence-based approaches to obesity assessment and care in the clinical setting. Obesity Canada has created evidence-based obesity competencies for medical education that can guide curriculum development, assessment and evaluation and be applied to health professionals' education programs in Canada and across the world.

Bariatric surgery is an effective weight loss tool that results in sustained weight loss, improvement in obesity-related comorbidities, and positive psychosocial outcomes. However, bariatric procedures also present with risks, as surgical complications are not uncommon.

Project Extension for Community Healthcare Outcomes (Project ECHO©) addresses urban-rural disparities in access to specialist care by building primary care provider (PCP) capacity through tele-education. Evidence supporting the use of this model for mental health care is limited. Therefore, this study evaluated a mental health and addictions-focused ECHO program. Primary outcome measures were PCP knowledge and perceived self-efficacy. Secondary objectives included: satisfaction, engagement, and sense of professional isolation. PCP knowledge and self-efficacy were hypothesized to improve with participation. Using Moore’s evaluation framework, we evaluated the ECHO program on participant engagement, satisfaction, learning, and competence. A pre-post design and weekly questionnaires measured primary and secondary outcomes, respectively. Knowledge test performance and self-efficacy ratings improved post-ECHO (knowledge change was significant, p< 0.001, d= 1.13; self-efficacy approached significance; p= 0.056, d= 0.57). Attrition rate was low (7.7%) and satisfaction ratings were high across all domains, with spokes reporting reduced feelings of isolation. This is the first study to report objective mental health outcomes related to Project ECHO. The results indicate high-participant retention is achievable, and provide preliminary evidence for increased knowledge and self-efficacy. These findings suggest this intervention may improve mental health management in primary care.

A position paper developed by the Canadian Psychiatric Association’s Education Committee and approved by the CPA’s Board of Directors on August 15, 2016.

The purpose of this study was to evaluate the relationship between patient, clinical and laboratory characteristics, and bleeding after bariatric surgery. A retrospective chart review was performed for all patients, who underwent a laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at our institution between March 2012 and May 2014. In total, 788 patients were included in this study. Seventeen patients had postoperative bleeding. The demographics, comorbidities, and preoperative medications were similar between the groups. Mean postoperative hemoglobin in the bleeding group was significantly lower (94 vs. 126; P<0.001) with a larger decrease from the baseline value (−43 vs. −12; P<0.001). The mean heart rate (91 vs. 81; P<0.001) and its increase from baseline (12 vs. −0.01; P<0.001) were significantly different in the bleeding patients. Postoperative hemoglobin and heart rate were associated with bleeding but not systolic blood pressure or patient characteristics. Further research is needed to develop a robust predictive model.